Thomas Piraino
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View article: Cuff leak test and airway obstruction in mechanically ventilated ICU patients (COSMIC): a pilot feasibility randomized controlled trial protocol
Cuff leak test and airway obstruction in mechanically ventilated ICU patients (COSMIC): a pilot feasibility randomized controlled trial protocol Open
Introduction The cuff leak test (CLT) is hypothesised to help optimise extubation by assessing for laryngeal oedema which, if unrecognised and untreated, could lead to post-extubation stridor, post-extubation airway obstruction, and reintu…
View article: Erroneous calibration of esophageal pressure in case of airway closure
Erroneous calibration of esophageal pressure in case of airway closure Open
Airway closure results in a lack of communication between proximal and distal airways unless the airway pressure (Paw) overcomes the airway opening pressure (AOP). This has been described in patients undergoing mechanical ventilation with …
View article: Clinical Outcomes of Children Meeting the At‐Risk for PARDS Criteria Before PICU Admission: A Single‐Center Study
Clinical Outcomes of Children Meeting the At‐Risk for PARDS Criteria Before PICU Admission: A Single‐Center Study Open
Objective To evaluate the ability of the criteria “At‐risk for PARDS” to identify patients with acute respiratory infection hospitalized outside the pediatric intensive care unit (PICU) who are at high risk of developing pediatric acute re…
View article: Ventilation distribution during spontaneous breathing trials predicts liberation from mechanical ventilation: the VISION study
Ventilation distribution during spontaneous breathing trials predicts liberation from mechanical ventilation: the VISION study Open
Background Predicting complete liberation from mechanical ventilation (MV) is still challenging. Electrical impedance tomography (EIT) offers a non-invasive measure of regional ventilation distribution and could bring additional informatio…
View article: Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions
Electrical impedance tomography monitoring in adult ICU patients: state-of-the-art, recommendations for standardized acquisition, processing, and clinical use, and future directions Open
Electrical impedance tomography (EIT) is an emerging technology for the non-invasive monitoring of regional distribution of ventilation and perfusion, offering real-time and continuous data that can greatly enhance our understanding and ma…
View article: Post-insufflation diaphragm contractions in patients receiving various modes of mechanical ventilation
Post-insufflation diaphragm contractions in patients receiving various modes of mechanical ventilation Open
Background During mechanical ventilation, post-insufflation diaphragm contractions (PIDCs) are non-physiologic and could be injurious. PIDCs could be frequent during reverse-triggering, where diaphragm contractions follow the ventilator rh…
View article: Respiratory drive heterogeneity associated with systemic inflammation and vascular permeability in acute respiratory distress syndrome
Respiratory drive heterogeneity associated with systemic inflammation and vascular permeability in acute respiratory distress syndrome Open
Background In acute respiratory distress syndrome (ARDS), respiratory drive often differs among patients with similar clinical characteristics. Readily observable factors like acid–base state, oxygenation, mechanics, and sedation depth do …
View article: Electrical Impedance Tomography to Monitor Hypoxemic Respiratory Failure
Electrical Impedance Tomography to Monitor Hypoxemic Respiratory Failure Open
Hypoxemic respiratory failure is one of the leading causes of mortality in intensive care. Frequent assessment of individual physiological characteristics and delivery of personalized mechanical ventilation (MV) settings is a constant chal…
View article: Lung Recruitment Assessed by Electrical Impedance Tomography (RECRUIT): A Multicenter Study of COVID-19 Acute Respiratory Distress Syndrome
Lung Recruitment Assessed by Electrical Impedance Tomography (RECRUIT): A Multicenter Study of COVID-19 Acute Respiratory Distress Syndrome Open
Rationale: Defining lung recruitability is needed for safe positive end-expiratory pressure (PEEP) selection in mechanically ventilated patients. However, there is no simple bedside method including both assessment of recruitability and ri…
View article: Magnitude of Synchronous and Dyssynchronous Inspiratory Efforts during Mechanical Ventilation: A Novel Method
Magnitude of Synchronous and Dyssynchronous Inspiratory Efforts during Mechanical Ventilation: A Novel Method Open
"Magnitude of Synchronous and Dyssynchronous Inspiratory Efforts during Mechanical Ventilation: A Novel Method." American Journal of Respiratory and Critical Care Medicine, 207(9), pp. 1239–1243
View article: A novel capnogram analysis to guide ventilation during continuous chest compressions resuscitation. From clinical to experimental observations
A novel capnogram analysis to guide ventilation during continuous chest compressions resuscitation. From clinical to experimental observations Open
Background : Cardio-Pulmonary Resuscitation (CPR) decreases lung volume below the functional residual capacity and can generate intrathoracic airway closure. Conversely, large insufflations can induce thoracic distension and jeopardize cir…
View article: AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen in the Acute Care Setting
AARC Clinical Practice Guideline: Management of Adult Patients With Oxygen in the Acute Care Setting Open
Providing supplemental oxygen to hospitalized adults is a frequent practice and can be administered via a variety of devices. Oxygen therapy has evolved over the years, and clinicians should follow evidence-based practices to provide maxim…
View article: One-Year Readmission Following Undifferentiated Acute Hypercapnic Respiratory Failure
One-Year Readmission Following Undifferentiated Acute Hypercapnic Respiratory Failure Open
Patients with acute hypercapnic respiratory failure (AHRF) often require hospitalization and respiratory support. Early identification of patients at risk of readmission would be helpful. We evaluated 1-y readmission and mortality rates of…
View article: The cuff leak test in critically ill patients: An international survey of intensivists
The cuff leak test in critically ill patients: An international survey of intensivists Open
Background The cuff leak test (CLT) is used to assess laryngeal edema prior to extubation. There is limited evidence for its diagnostic accuracy and conflicting guidelines surrounding its use in critically ill patients who do not have risk…
View article: Lung Volume Measurement and Ventilation Distribution During Invasive Mechanical Ventilation
Lung Volume Measurement and Ventilation Distribution During Invasive Mechanical Ventilation Open
Lung volume measurement performed during invasive mechanical ventilation can be used to determine functional residual capacity, changes in end-expiratory lung volume with the application of PEEP, and lung strain. However, many bedside meas…
View article: Lung Expansion Therapy: Please, (Visually) Show Me the Value!
Lung Expansion Therapy: Please, (Visually) Show Me the Value! Open
The postoperative period for patients has been a focus of research for decades. In the early 1940s, a number of publications began to surface that challenged the common practice of therapeutic bed rest after surgery.[1][1] The resulting ev…
View article: Comparison of ventilatory modes to facilitate liberation from mechanical ventilation: protocol for a systematic review and network meta-analysis
Comparison of ventilatory modes to facilitate liberation from mechanical ventilation: protocol for a systematic review and network meta-analysis Open
Introduction Timely liberation from invasive mechanical ventilation is important to reduce the risk of ventilator-associated complications. Once a patient is deemed ready to tolerate a mode of partial ventilator assist, clinicians can use …
View article: The Role of Specialty Tubes in Preventing Ventilator-Associated Events
The Role of Specialty Tubes in Preventing Ventilator-Associated Events Open
There have been many innovations to the standard endotracheal tube over the years, many of which were intended to reduce the incidence of ventilator-associated pneumonia (VAP). Ventilator-associated events are associated with the objective…
View article: Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC): a pilot randomised controlled trial protocol
Cuff Leak Test and Airway Obstruction in Mechanically Ventilated ICU Patients (COMIC): a pilot randomised controlled trial protocol Open
Introduction Endotracheal intubation and invasive mechanical ventilation are lifesaving interventions that are commonly performed in the intensive care unit (ICU). Laryngeal oedema is a known complication of intubation that may cause airwa…
View article: Noninvasive Respiratory Support in Acute Hypoxemic Respiratory Failure
Noninvasive Respiratory Support in Acute Hypoxemic Respiratory Failure Open
For more than 40 years, noninvasive ventilation has been the first-line preferred therapy for acute-on-chronic conditions, such as COPD and cardiogenic pulmonary edema. The use of noninvasive ventilation in the treatment of hypoxemic respi…